Re-Opening Delaware Early Care and Education Safely

Re-Opening Delaware Early Care and Education Safely:

A Blueprint for Supporting Our Early Childhood Professionals During COVID-19

Revised August 16, 2021

RE-OPENING DELAWARE EARLY CARE AND EDUCATION SAFELY: A BLUEPRINT FOR SUPPORTING OUR EARLY CHILDHOOD PROFESSIONALS DURING COVID-19

Contents Introduction ...... 2 Document Updates ...... 3 HOW DOES THE STATE OF EMERGENCY INFLUENCE CHILD CARE IN DELAWARE? ...... 6 WHAT FINANCIAL RESOURCES ARE AVAILABLE IN DELAWARE? ...... 7 Financial Resources to Assist Child Care Programs ...... 7 Child Care Stabilization Grants ...... 7 Paycheck Protection Program (PPP) ...... 7 Unemployment ...... 7 Financial Resources to Assist Families ...... 8 WHO CAN I PROVIDE CARE FOR? ...... 9 HOW SHOULD I CHANGE MY OPERATING PROCEDURES? ...... 10 Revised Group Size, Ratio Requirements, and Staffing ...... 11 Minimize Risk at Drop Off and Pick Up Times ...... 13 Facility Access...... 13 Screening Procedures ...... 14 Guidelines for Cleaning and Disinfecting the Environment ...... 16 Handwashing ...... 18 Diapering and Toileting ...... 19 Minimize Risk While Caring for Children ...... 20 Healthy Hygiene Practices...... 20 Physical Distancing ...... 22 Outside Play & Physically Active Play ...... 23 Meals & Snacks ...... 24 Activities ...... 24 WHAT SHOULD I DO IF SOMEONE IN MY PROGRAM GETS SICK? ...... 25 APPENDIX: WHAT SHOULD I KNOW ABOUT COVID-19 VACCINATIONS? ...... 28 APPENDIX: HOW CAN I SUPPORT THE SOCIAL AND EMOTIONAL NEEDS OF EVERYONE IN MY PROGRAM? ...... 30 Supporting Early Childhood Professionals ...... 30 Talking with Children about COVID-19 ...... 31 APPENDIX: HOW CAN I MAKE SURE MY PROGRAM IS READY? ...... 34

Introduction

According to the Centers for Disease Control and Prevention (CDC), COVID-19 is a respiratory illness spread from person to person, through respiratory droplets of an infected individual. As health experts continue to gain a greater understanding of how COVID-19 spreads, what precautions are helpful, and other factors, information is being updated regularly on the CDC Coronavirus site.

Our goal is to support Delaware’s early childhood professionals as they continue caring for the children and families of Delaware. The information gathered in this document will serve to:

1) Keep you informed regarding Office of Child Care Licensing (OCCL) regulations related to COVID-19, as well as additional recommended practices to consider to keep you, your staff, the children, and our communities as safe as possible. Throughout this document, requirements specific to Delaware programs, as outlined by OCCL, are presented in gray boxes, and additional health & safety practices recommended by national experts are included in yellow boxes.

2) Direct you through thoughtful considerations for continuing to operate under current regulations and as potentially more children and staff return. A sample risk management assessment tool is included in the Appendix.

3) Guide you through resources available to all programs and early childhood professionals.

OCCL licensing specialists are available to assist with clarification of this guidance, and Delaware Stars technical assistants are also available to support you in how to implement it in your program.

As we learn more about this disease, such as how to treat it and how to contain it, orders, mandates, and declarations may change. • It is very important to check state and local health department notices daily about the spread of COVID-19 in the area and adjust operations accordingly. • Click on the links below to get up-to-date information for Delaware. Delaware’s Response to Coronavirus Disease CDC’s page dedicated to COVID-19

NOTE: Information in this document is current as of 8/16/2021. This document will be updated on an ongoing basis to reflect current information from the state of Delaware.

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Document Updates Most recent updates will be in orange. 8/16/21 • How Does the State of Emergency Influence Child Care in Delaware? – Latest update from the state • All sections have been updated to reflect that all Delaware programs must follow the current DELACARE Regulations • All sections have been updated to reflect the latest CDC guidance. Be sure to check with the CDC directly for the most up-to-date guidelines. • How Should I Change My Operating Procedures? – CDC link • Revised Group Size, Ratio Requirements, and Staffing – Update to Intern requirements and reminders of current regulations for fingerprinting and CPR requirements • Facility Access; Screening Procedures – Reminder of current regulations and mask wearing requirements • Guidelines for Cleaning and Disinfecting the Environment – Reminder of handwashing requirements when using playdough/clay • Handwashing – Reminder of handwashing regulations and recommendation to continue to wash hands when moving between classrooms • Healthy Hygiene Practices – Face covering requirements, effective 8/16/21 • Physical Distancing – No longer required, but recommended when possible • Activities – Reminder of screen time requirements in current regulations • What Should I Do if Someone in My Program Gets Sick? – Updated vaccine email for DPH

5/13/21 • Revised Group Size, Ratio Requirements, and Staffing; Healthy Hygiene Practices; Physical Distancing – Physical distancing reduced to 3 feet • Facility Access; Physical Distancing – Adults may enter classrooms at drop off/pick up; Hallway recommendations • Screening Procedures – Self-checks may replace on-site checks • Guidelines for Cleaning and Disinfecting the Environment – Clarification on cleaning expectations

5/3/21 • Revised Group Size, Ratio Requirements, and Staffing; Physical Distancing – Group sizes returning to pre- COVID-19

4/21/21 • Physical Distancing; Activities – Field trips are now permitted, with specific guidance

4/15/21 • Financial Resources to Assist Child Care Programs – updates to current programs and additional opportunities • Facility Access – who is permitted to enter the facility • Screening Procedures – for vaccinated individuals • Guidelines for Cleaning and Disinfecting the Environment – sand play and use of pools • Physical Distancing – who is permitted to enter the facility • What Should I Do If Someone In My Program Gets Sick? – reporting requirements and procedures

3/12/21

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• How Should I Change My Operating Procedures? – CDC guidelines regarding protecting your child care center; children and COVID-19, including updates for children with special needs and disabilities • Revised Group Size, Ratio Requirements, and Staffing; Minimize Risk at Drop Off and Pick Up Times; Physical Distancing – CDC guidance for cohorts and staggering strategies • Revised Group Size, Ratio Requirements, and Staffing – CDC guidance for protections for staff at higher risk • Facility Access – CDC Guidance for Direct Service Providers (DSPs) • Screening Procedures – CDC updates • Guidelines for Cleaning and Disinfecting the Environment – CDC resource on ventilation; CDC updates to water systems; CDC guidelines for communal spaces • Handwashing – CDC Warning about hand sanitizers • Outside Play – CDC updates on cleaning and staggering schedules • Meals & Snacks – CDC updated guidance • What Should I Do If Someone In My Program Gets Sick? – CDC resources • Appendix – Vaccination Information

2/25/21 • Financial Resources to Assist Child Care Programs – updates to current programs and additional opportunities The following updates are effective March 1, 2021 • Revised Group Size, Ratio Requirement, and Staffing – CPR certification requirements • Facility Access – additional entities allowed access; guidance for in-person tours • Screening Procedures – clarification of quarantine directions for positive test results • What Should I Do If Someone In My Program Gets Sick? – revised public health reporting guidelines

1/22/21 • Revised Group Size, Ratio Requirements, and Staffing – “School-Age” added to exception for Interns • Facility Access - expectations and exiting requirements • Screening Procedures - quarantine directions; close contact definition • Healthy Hygiene Practices - face coverings expectations

9/22/20: Facility Access – Option allowing families to enter the facility during drop off and pick up; access for CACFP

9/2/20: • How Does the State of Emergency Influence Child Care in Delaware - school-age reopening scenario; 25th modification • What Financial Resources are Available in Delaware - DE Relief Grants; PPP closed • Who Can I Provide Care For - information regarding school-age care • How Should I Change My Operating Procedures - COVID-19 Child Care Plan availability • Revised Group Size, Ratio Requirements, and Staffing - school-age updates; intern requirements; CDC recommendations for higher risk individuals • Facility Access - additional exceptions allowed to access facility • Screening Procedures - symptoms; documentation; close contact definition • Guidelines for Cleaning and Disinfecting the Environment - shared playdoh/clay and play masks/goggles; CDC recommendations • Handwashing - business requirements • Healthy Hygiene Practices - exceptions for face coverings; child requirements; social distancing Page | 4

• Physical Distancing - group size; expectations per age group • Outside Play - face covering exceptions • Activities - off-site field trips; modified screen time • What Should I Do If Someone in My Program Gets Sick - required reporting; guidance on next steps • How Can I Make Sure My Program is Ready - reflects updates; new remote learning section

6/22/20: • Revised Group Size, Ratio Requirements, and Staffing - parameters for early childhood interns; Fingerprinting requirements

6/16/20: • Facility Access - outside contractors, enrichment programs, and entertainment • Screening Procedures - temperature requirements and implications; close contact requirements • Guidelines for Cleaning and Disinfecting the Environment - use of water tables

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HOW DOES THE STATE OF EMERGENCY INFLUENCE CHILD CARE IN DELAWARE?

To slow the spread, or transmission, of COVID-19, Governor John Carney declared a State of Emergency effective March 13, 2020, with no direct changes to early care and education. This order was adjusted to include the Stay-at-Home Order effective March 24, 2020.

On March 30th, Governor Carney’s eighth modification to the State of Emergency permitted child care programs to apply to open as Emergency Child Care Sites and explained additional operating requirements for child care programs that chose to open during the COVID-19 State of Emergency.

The thirteenth modification of the State of Emergency, effective May 1, 2020, required adults and children over 12 years of age to wear face coverings in public settings. This modification also stated that due to the dangers of suffocation, children under age two must NOT wear facial coverings of any type. Early childhood professionals working in any child care setting are required to wear cloth face coverings while working, not just at arrival and dismissal times for children.

On May 15th, Governor Carney announced the Phase 1 of Delaware's Economic Reopening. During Phase 1, child care programs designated as Emergency Child Care Sites could provide care to employees of essential and/or reopened businesses who could not work from home and did not have alternate care options. Child care programs that closed during the State of Emergency were eligible to apply to become Emergency Child Care Sites on an on-going basis.

Delaware moved to Phase 2 on June 15th. As of June 15th, all previously issued guidelines pursuant to Executive Order 38, the 8th modification to the Governor’s State of Emergency, and the “additional requirements for DSCYF-Designated Emergency Child Care Sites” are no longer applicable. As part of Phase 2, licensed child care programs are permitted to open and serve all families seeking child care. Open licensed child care programs are required to follow applicable DELACARE Regulations as well as additional health and safety requirements developed by the Office of Child Care Licensing (OCCL) and the Division of Public Health (DPH).

On August 4th, Governor Carney announced that Delaware K-12 schools may reopen in Hybrid Scenario, with a mix of remote and in-person instruction.

On August 26th, Governor Carney issued the 25th modification to the State of Emergency, formalizing new face covering requirements for children and requiring schools to notify families of positive cases of COVID-19. The additional health and safety requirements were updated and guidance was provided for schools and child care programs regarding school-age care.

On August 10, 2021, Governor Carney announced that everyone kindergarten-age and older in child care homes and child care centers must wear face coverings indoors effective Monday, August 16, regardless of vaccination status. As of August 16, 2021, emergency child care regulations have been posted on the Delaware Department of Education (DDOE) website. These emergency regulations become effective on Monday, August 16, 2021. The following link (https://www.doe.k12.de.us/domain/89) will take you to the specific place on DDOE’s website where the emergency orders are posted.

Delaware continues to update information related to child care at https://coronavirus.delaware.gov/childcare/.

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WHAT FINANCIAL RESOURCES ARE AVAILABLE IN DELAWARE?

Financial Resources to Assist Child Care Programs

As your program adjusts to the additional restrictions and requirements as part of operating during the COVID-19 pandemic, resources are available to help you move forward. It is important to stay informed of possible additions or changes to available resources as updates continue to occur.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, signed into law March 27, 2020, and the America Rescue Plan (ARP) Act, signed into law March 11, 2021, allow States to provide economic assistance to businesses and workers for certain purposes related to pandemic relief. The list below reflects programs that are in place as of the release of this document, although information and opportunities continue to be updated.

Child Care Stabilization Grants As announced on April 9, 2021, the Delaware Early Education and Child Care Stabilization Fund will provide direct grants to cover eligible expenses from the COVID-19 pandemic, to help child care programs stay in business and make child care more affordable for families. Additional information, and the application, can be found on the Stabilization Fund webpage https://www.delawarestars.udel.edu/delaware-early-education-and- child-care-stabilization-fund/.

Paycheck Protection Program (PPP) According to the Small Business Administration (SBA), “The Paycheck Protection Program is a loan designed to provide a direct incentive for small businesses to keep their workers on the payroll.” PPP ended on May 31, 2021. Existing borrowers may be eligible for PPP loan forgiveness.

Emergency Economic Injury Disaster Loan (EIDL) Covid-19 Economic Injury Disaster Loans are available to small businesses to cover operating costs, including paid sick leave, payroll, and rent or mortgage payments.

Minority Business Development Agency The MBDA provides grants to SBA resource partners such as Small Business Development Centers and the Women’s Business Center and waives the non-federal match.

Unemployment The Division of Unemployment Insurance has information for those typically eligible for unemployment benefits.

Independent contractors and self-employed individuals may be eligible for unemployment through Pandemic Unemployed Assistance (PUA). This opportunity has been extended through September 6, 2021.

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Financial Resources to Assist Families

This is uncharted territory for everyone. Some families may need assistance in ways they have never required help before. Delaware 2-1-1 is a free-of-charge, confidential referral and information helpline and website that connects people from all communities and of all ages to the essential health and human services they need. To access the helpline via phone, dial 2-1-1 or 1-800-560-3372 to reach a community resource specialist Monday-Friday, 8 am through 9 pm. Families can also text their zip code to 898-211 for assistance.

Some additional resources that may be helpful include:

• Purchase of Care (POC) – This is a program available to provide financial support to families who need assistance paying for child care, if they meet certain financial requirements. Additional information can be downloaded or printed from this information brochure.

For families seeking school-age child care to support remote learning, depending on a licensed provider or camp’s policies, parents/guardians may need to pay for child care. Families are encouraged to contact providers or POC directly at 1-866-843-7212 to inquire about program costs.

• Community Food Banks – The mission of the Delaware Food Bank is “… to provide nutritious foods to Delawareans in need and facilitate long-term solutions to the problems of hunger and poverty through community education and advocacy.” Information regarding programs they offer and locations can be found here.

• Delaware Healthy Children (DHC) – DHC is a low-cost health insurance program available to uninsured children in our state. Information regarding eligibility requirements, services covered, and how to apply can be found here.

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WHO CAN I PROVIDE CARE FOR?

Child care may be provided to all families seeking child care from a child care program licensed by the Office of Child Care Licensing (OCCL).

All Delaware programs must follow the current DELACARE Regulations.

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HOW SHOULD I CHANGE MY OPERATING PROCEDURES?

What are Delaware’s required practices? All Delaware programs must follow the current DELACARE Regulations.

The Center for Disease Control and Prevention (CDC) will provide updates as needed at: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/index.html. Please follow their guidance regarding COVID-19 recommendations.

What are additional recommended practices? From Centers for Disease Control and Prevention The CDC also provides the following: • Quick Guide: Help Protect your Child Care Center from COVID-19 • Quick Guide: Help Protect your Family Child Care Home from COVID-19 • While fewer children have been sick with COVID-19 compared with adults during the pandemic, children can be infected with the SARS-CoV-2 virus that causes COVID-19, can get sick with COVID- 19, and can spread the virus to others. CDC’s science brief on transmission in schools includes information on scientific evidence on the spread of SARS-CoV-2 among children and in school and ECE settings. • Most ECE programs serve children under 12 years of age who are not eligible for vaccination at this time. Therefore, this guidance emphasizes implementing layered COVID-19 prevention strategies (e.g., using multiple prevention strategies together) to protect people who are not fully vaccinated, including infants and children (hereafter called children), staff, and other members of their households. The guidance is intended to help programs and local health officials select appropriate, layered prevention strategies and understand how to safely transition their care environments out of COVID-19 pandemic precautions as community transmission of COVID-19 reaches low levels. This guidance is based on current scientific evidence and lessons learned from schools and ECEs implementing COVID-19 prevention strategies.

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Revised Group Size, Ratio Requirements, and Staffing

What are Delaware’s required practices? All Delaware programs must follow the current DELACARE Regulations. These include: • New staff must be fingerprinted for a Delaware SBI and FBI check before the start of employment. The fingerprint verification form must be provided to the employer before working with children. • The skills demonstration is required for any new or renewed CPR certification earned after July 13, 2021.

Use of Interns in Centers: OCCL is temporarily granting a variance to all child care centers on the possible use of interns (center regulations 24K and 87D) at least until December 31, 2021. How interns will be used in an individual child care center is the decision of each facility until December 31, 2021. A licensed child care center may follow the current DELACARE Regulations regarding the use of Early Childhood or School-Age Interns or may follow the modified requirements shown below. Until December 31, 2021, center staff may be alone with children after meeting these requirements: • Is qualified as at least an early childhood or school-age intern by Delaware First; • Is at least 18 years old; • Has been determined eligible by the Criminal History Unit after completion of a comprehensive background check; and • Has at least one month of employment at the current center and has been oriented to the policies and procedures of that center and DELACARE Regulations.

It is recommended that centers place their more experienced staff with the younger children they serve.

What are additional recommended practices? From Centers for Disease Control and Prevention • ECE administrators can promote health equity by ensuring all staff and children have resources to support physical and mental health. ECE administrators can offer modified job responsibilities for staff at higher risk for severe illness who have not been fully vaccinated while protecting individual privacy. Federal and state disability laws may require an individualized approach for working with children and youth with disabilities consistent with the child’s Individualized Family Service Plan (IFSP), Individualized Education Program (IEP), or Section 504 plan. Administrators should consider adaptations and alternatives to prevention strategies when serving people with disabilities, while maintaining efforts to protect all children and staff from COVID-19. • ECE programs where not everyone is fully vaccinated should implement physical distancing to the extent possible indoors. Because of the essential service that ECE programs provide, ECE programs should not exclude children from in-person care to keep a minimum distance requirement. • Maintaining physical distance is often not feasible in an ECE setting, especially during certain activities (e.g., diapering, feeding, holding/comforting, etc.) and among younger children in general. When it is not possible to maintain physical distance in ECE settings, it is especially important to layer multiple prevention strategies, such as cohorting, masking indoors, improved ventilation, handwashing, covering coughs and sneezes, and regular cleaning to help reduce transmission risk. Mask use by

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people who are not fully vaccinated is particularly important when physical distance cannot be maintained. A distance of at least 6 feet is recommended between adults who are not fully vaccinated. Place children and child care providers into distinct groups that stay together throughout an entire day. • People who are fully vaccinated do not need to physically distance except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance. Although challenging and at times not possible in an ECE setting, people who are not fully vaccinated should physically distance from others who are not fully vaccinated as much as possible and wear a mask. • Cohorting: Cohorting means keeping people together in a small group and having each group stay together throughout an entire day. Cohorting can be used to limit the number of children and staff who come in contact with each other, especially when it is challenging to maintain physical distancing, such as among young children, particularly in areas of moderate-to-high transmission levels. The use of cohorting can limit the spread of COVID-19 between cohorts but should not replace other prevention measures within each group. When determining how to ensure physical distance and size of cohorts, ECE programs should consider education loss and social and emotional well-being of children, and the needs of the families served when they cannot attend ECE programs in person. • Place children and child care providers into distinct groups that stay together throughout the entire day. • If possible, your child care groups should include the same children each day, and the same child care providers should remain with the same group of children each day. • Limit mixing between groups such that there is minimal or no interaction between groups or cohorts. • The number of cohorts or groups may vary depending on child care program type (centers versus homes) and size, with smaller programs having fewer cohorts than larger ones. • Maintain at least 6 feet between children and staff from different cohorts. • Separate children’s naptime mats or cribs and place them so that children are head to toe for sleeping. Masks should not be worn when sleeping. • Provide physical guides, such as wall signs or tape on floors, to help maintain distance between cohorts in common areas. • Stagger use of communal spaces between cohorts. • Stagger child arrival, drop-off, and pick-up times or locations by cohort and prioritize outdoor drop-off and pick-up, if possible. • In transport vehicles, seat one child per row or skip rows when possible. Children from the same home can sit together. • Prioritize outdoor activities. When possible, physically active play should be done outside. Maintain cohorts if feasible in outdoor play spaces. Masks should not be worn when swimming or playing in water. • Provide accommodations, modifications, and assistance for children and staff with disabilities or special healthcare needs when implementing COVID-19 safety protocols. Access additional information here. • ECE programs should have an Emergency Operations Plan (EOP) in place to protect children, staff, and families from the spread of illness and other emergencies. Further details can be found here.

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Minimize Risk at Drop Off and Pick Up Times Facility Access

What are Delaware’s required practices? All Delaware programs must follow the current DELACARE Regulations.

For the health and safety of staff and children in your care, the following practices are strongly recommended but are no longer required: • Health screenings of children and adults entering your facility is no longer required. Unless they are ill, families may enter the child care facility at any time while their child is in care. See DELACARE Regulations 23 (centers) and 13T (family/large family). (However, masks must be worn by anyone kindergarten age and older entering your facility; this includes staff, families, contractors, visitors, etc. regardless of vaccination status.)

What are additional recommended practices? From Centers for Disease Control and Prevention • Given new evidence on the B.1.617.2 (Delta) variant, CDC has updated the guidance for fully vaccinated people. CDC recommends universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status. Children should return to full-time in- person learning in the fall with layered prevention strategies in place. • Set up hand hygiene stations at facility entrances. • ECE programs should review their rules for visitors and family engagement activities. o ECE programs should limit nonessential visitors, volunteers, and activities involving external groups or organizations with people who are not fully vaccinated, particularly in areas when there is moderate-to-high COVID-19 community transmission. o ECE programs should not limit access for DSPs or mothers who are breastfeeding their infants, but can ensure compliance with ECE program visitor polices. o Develop plans for meeting new families that allow family and staff to gather while maintaining prevention strategies. o Develop plans or procedures for parents and/or guardians to visit their children while maintaining prevention strategies. o Home-based ECE programs with people living in the home who are not fully vaccinated should require mask-wearing for unvaccinated persons and keep as much physical distance as possible. o Home visitors may consult the Health Resources and Services Administration’s Home Visiting Information During COVID-19.

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Screening Procedures

What are Delaware’s required practices? All Delaware programs must follow the current DELACARE Regulations.

What are additional recommended practices? From Centers for Disease Control and Prevention Staying Home When Sick • Children and staff who have symptoms of infectious illness, such as influenza (flu) or COVID-19, should stay home and be referred to their healthcare provider for testing and care. Staying home when sick with COVID-19 is essential to keep COVID-19 infections out of programs and prevent spread to others. It also is essential for people who are not fully vaccinated to quarantine after a recent exposure to someone with COVID-19. ECE programs should also allow flexible, non-punitive, and supportive paid sick leave policies and practices that encourage sick workers to stay home without fear of retaliation, loss of pay, or loss of employment. Employers should ensure that workers are aware of and understand these policies. • The overlap between COVID-19 symptoms with other common illnesses means that some people with symptoms of COVID-19 could be ill with something else. This is even more likely in young children, who typically have multiple viral illnesses each year. Although COVID-19, colds, and flu illnesses have similar symptoms, they are different diseases. Children who have symptoms of infectious illness or certain symptoms of COVID-19 should not attend your ECE program. Encourage your families to be on the alert for signs of illness in their children and to keep them home when they are sick. Parents should pay particular attention to o Fever (temperature 100.4 ºF or higher) o Sore throat o New uncontrolled cough that causes difficulty breathing (for a child with chronic allergic/asthmatic cough, see if there is a change from their usual cough) o Diarrhea, vomiting, or stomachache o New onset of severe headache, especially with a fever • People who have a fever of 100.4 ºF (38.0 ºC) or above or other signs of illness should not be admitted to your facility. • The length of time the child should stay out of child care depends on whether the child has COVID- 19 or another illness. In most instances, those who have COVID-19 can be around others after o 10 days since symptoms first appeared and o 24 hours with no fever without the use of fever-reducing medications and o Other symptoms of COVID-19 are improving Page | 14

Getting Tested for COVID-19 Getting tested for COVID-19 when symptoms are compatible with COVID-19 will help with rapid contact tracing and prevent possible spread, especially if key prevention strategies (masking and distancing) are not in use. • Encourage families to monitor children at home for signs of infectious illness including COVID-19 to decide when to seek testing or medical care. • Develop policies that encourage sick employees to stay at home without fear of negative consequences. Ensure policies are clearly communicated to staff. CDC’s criteria can help inform when children and unvaccinated staff can return if they have recently had close contact with a person with COVID-19. • Develop and communicate with staff and families about your policies for returning to your ECE program after COVID-19 illness. CDC’s criteria to discontinue home isolation and quarantine can inform these policies. • ECE programs should offer referrals to diagnostic testing to any child or staff member who is exhibiting symptoms of COVID-19 in the ECE setting. • Some ECE programs may also elect to use screening testing for unvaccinated staff as a strategy to identify cases and prevent secondary transmission. This includes screening testing of asymptomatic people without known exposure with the intent of making decisions based on the test results. ECE programs interested in offering screening testing to staff should contact their local health department to discuss options for implementation.

• The CDC has the following resources: o Child Care Providers Quick Guide Symptoms of COVID-19 at Child Care o COVID-19 Child Care Symptom Screening Flowchart

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Guidelines for Cleaning and Disinfecting the Environment

What are Delaware’s required practices? All programs must continue to follow DELACARE Regulations.

• Play dough and clay may be shared among different children. (DELACARE Regulations require handwashing after using shared clay/dough.)

What are additional recommended practices? It is important to review and update your program’s cleaning, sanitizing, and disinfecting schedule. If you need help determining when cleaning, sanitizing, and disinfecting is required, further information is offered by Caring for Our Children here. The CDC also has detailed recommendations regarding cleaning, sanitizing, and disinfecting at child care settings. In addition, the CDC provides a resource in ventilation for child care settings.

From Centers for Disease Control and Prevention • In general, cleaning once a day is usually enough to sufficiently remove potential virus that may be on surfaces. However, in addition to cleaning for COVID-19, ECE programs should follow recommended procedures for cleaning and disinfection in their setting (e.g. after diapering, feeding, and exposure to bodily fluids). See Caring for Our Children. For more information on cleaning a facility regularly, when to clean more frequently or disinfect, cleaning a facility when someone is sick, safe storage of cleaning and disinfecting products, and considerations for protecting workers who clean facilities, see Cleaning and Disinfecting Your Facility. • When Someone is Sick: If someone in the ECE program is sick or someone who has COVID-19 has been in the facility in the last 24 hours, clean and disinfect your facility. For more information on cleaning and disinfecting safely, see Cleaning and Disinfecting Your Facility. • Additional considerations for cleaning and disinfection: • Ensure that personal items such as masks or toothbrushes are used only by one child and stored safely while not in use (for example, in individually labeled containers, bags, or cubbies). Ensure that children and staff wash hands after handling these personal items. • Follow recommendations on cleaning and sanitizing toys. • Learn how to reduce the chance of an asthma attack while disinfecting. • Consider contacting the state ECE office to see if additional resources are available to obtain cleaning and disinfecting supplies through the Federal Emergency Management Agency or Child Care Resource and Referral Agency. • Ensure safe and correct application of disinfectants and keep products away from children. • Improving ventilation is an important COVID-19 prevention strategy that can reduce the number of virus particles in the air. Along with other preventive strategies, including wearing a well-fitting, multi- layered mask, bringing fresh outdoor air into a building helps keep virus particles from concentrating inside. This can be done by opening multiple doors and windows, using child-safe fans to increase the effectiveness of open windows, and making changes to the HVAC or air filtration systems.

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• During transportation, open or crack windows in buses and other forms of transportation, if doing so does not pose a safety risk. Keeping windows open a few inches improves air circulation. • For more specific information about maintenance, use of ventilation equipment, actions to improve ventilation, and other ventilation considerations, refer to: • Ventilation in Schools and Child Care Programs • Ventilation FAQs • Improving Ventilation in Your Home

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Handwashing

What are Delaware’s required practices? All programs must continue to follow DELACARE Regulations.

For the health and safety of staff and children in your care, the following practices are strongly recommended but are no longer required: • Staff and children do not have to wash hands upon entering and leaving a classroom but this practice is encouraged. You must comply with hand washing requirements in DELACARE Regulations (regulation 59 in centers or 38 in family/large family homes).

What are additional recommended practices? Caring for Our Children offers clarification on both hand washing procedures and hand washing schedules.

From Centers for Disease Control and Prevention Warning: Hand Sanitizers Packaged Like Food or Drinks The U.S. Food and Drug Administration (FDA) is warning consumers about alcohol-based hand sanitizers that are being packaged in containers that may appear as food or drinks and some that contain food flavors. Eating or drinking these products can cause serious injury or death. FDA Warning

• People should practice handwashing and respiratory etiquette (covering coughs and sneezes) to keep from getting and spreading infectious illnesses including COVID-19. ECE programs can monitor and reinforce these behaviors and provide adequate handwashing supplies. • Teach and reinforce handwashing with soap and water for at least 20 seconds. • Remind everyone in the facility to wash hands frequently and assist young children with handwashing. • If handwashing is not possible, use hand sanitizer containing at least 60% alcohol (for staff and older children who can safely use hand sanitizer). Hand sanitizers should be stored up, away, and out of sight of young children and should be used only with adult supervision for children under 6 years of age. • Post signs and graphics that describe how to stop the spread of germs in important facility locations such as entrances and restrooms. Signs should be easy to understand, use pictures, and be in primary languages spoken by your staff and families. • Set up hand hygiene stations at facility entrances. • Wearing gloves is not necessary for protection from COVID-19 in most situations. CDC does recommend wearing gloves when cleaning and disinfecting or when caring for someone who is sick with COVID-19, but otherwise proper handwashing is recommended. • Resources on handwashing and respiratory etiquette • COVID-19 Communication Resources • Toolkit for Child Care Programs • Cleaning, Disinfection, and Hand Hygiene in Schools – a Toolkit for School Administrators • COVID-19 videos including one with American Sign Language and other communication tools • Coughing and Sneezing

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Diapering and Toileting

What are Delaware’s required practices? All Delaware programs must follow the current DELACARE Regulations.

What are additional recommended practices? From Centers for Disease Control and Prevention • When diapering a child, wash your hands and wash the child’s hands before you begin, and wear gloves. Follow safe diaper-changing procedures. • Where feasible, diapering should not be done by the same person who prepares food. If you are the only person available for both diapering and food preparation, use additional prevention strategies (such as handwashing) between diapering and food preparation. • After diapering, take off gloves and wash your hands (even if you were wearing gloves) and disinfect the diapering area with a fragrance-free disinfectant on the EPA List N: Disinfectants for Coronavirus (COVID-19) as a sanitizing or disinfecting solution. If other products are used for sanitizing or disinfecting, they should also be fragrance-free and EPA-registered. If the surface is dirty, it should be cleaned with detergent or soap and water prior to disinfection. • If reusable cloth diapers are used, do not rinse or clean them in your facility. Place the soiled cloth diaper and its contents (without emptying or rinsing) in a plastic bag or into a plastic-lined, hands-free covered diaper pail to give to parents or guardians or laundry service. (Download posters with diaper changing procedures.)

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Minimize Risk While Caring for Children

Healthy Hygiene Practices

What are Delaware’s required practices? All Delaware programs must follow the current DELACARE Regulations.

• The following emergency regulations become effective for all licensed child care on Monday, August 16, 2021 and will remain in effect for 120 days: 1. All persons or programs conducting child care shall recommend mask use by children ages 2 through pre-kindergarten. 2. All persons or programs conducting child care shall require mask use by children in kindergarten through twelfth grade, plus all staff, family members, and visitors inside the child care facility, regardless of vaccination status. 3. Persons with a medical condition or disability that prevents them from wearing a mask can request a reasonable accommodation from the child care facility. These accommodations must be available for OCCL review if requested. 4. Masks are not required in child care homes or facilities in the following instances: • When seated at a table to eat or drink • When asleep or napping • When engaged in any activity that makes wearing a mask not feasible, such as swimming • When a person is in a personal space (i.e., single office) and others outside of that person’s household are not present • When outdoors • When children are not in the building

• Child care center and family/large family child care educators are strongly encouraged to require masks for children 2 years old to kindergarten inside their facilities/homes to prevent spread of COVID-19. • Children younger than 2 years old should not wear masks due to risk of suffocation. • Masks are required when travelling on a bus or in a car with others not in your immediate family.

What are additional recommended practices? • Parents/guardians and child care staff should discuss the considerations in this document for each individual child, and consult with the child’s health care provider if necessary (e.g., for children with certain conditions such as asthma), to determine if an individual child is able to safely and consistently wear a cloth face covering while in child care. • There are a variety of strategies parents/guardians and child care providers can use to assist children with becoming comfortable wearing cloth face coverings. Parents/guardians are encouraged to practice these strategies at home to help their child become comfortable with wearing a cloth face covering prior to use of a cloth face covering in a child care.

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From Centers for Disease Control and Prevention • Given new evidence on the B.1.617.2 (Delta) variant, CDC has updated the guidance for fully vaccinated people. CDC recommends universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status. Children should return to full-time in-person learning in the fall with layered prevention strategies in place. • Masks should be worn indoors by all individuals (ages 2 and older) who are not fully vaccinated. ECE settings may implement universal mask use in some situations, such as if they serve a population not yet eligible for vaccination or if they have increasing, substantial, or high COVID-19 transmission in their ECE program or community. • When people who are not fully vaccinated wear a mask correctly and consistently, they protect others as well as themselves. Consistent and correct mask use by people who are not fully vaccinated is especially important indoors and when physical distancing cannot be maintained. • Indoors: Mask use is recommended for people who are not fully vaccinated, including children and staff. Children under 2 years of age should not wear a mask. • Outdoors: In general, people do not need to wear masks when outdoors. However, particularly in areas of substantial to high transmission, CDC recommends that people age 2 and older who are not fully vaccinated wear a mask in crowded outdoor settings or during activities that involve sustained close contact with other people who are not fully vaccinated. • Based on the needs of the community, ECE programs may opt to make mask use universally required (i.e., required regardless of vaccination status) in the program. Reasons for this can include: • Serving a population that is not yet eligible for vaccination; which includes most ECE programs. • Having staff model consistent and correct mask use for children aged 2 and older. • Increasing or substantial or high COVID-19 transmission within the program or their surrounding community. • Increasing community transmission of a variant that is spread more easily among children or is resulting in more severe illness from COVID-19 among children. • Lacking a system to monitor the vaccine status of children and staff. • Difficulty monitoring or enforcing mask policies that are not universal. • Awareness of low vaccination uptake within families, staff, or within the community. • Programs that continue to require people older than 2 years of age to wear a mask should make exceptions for the following categories of people: • A person who cannot wear a mask, or cannot safely wear a mask, because of a disability as defined by the Americans with Disabilities Act (ADA) (42 U.S.C. 12101 et seq.). Discuss the possibility of reasonable accommodation with workers who are not fully vaccinated who are unable to wear or have difficulty wearing certain types of masks because of a disability. • A person for whom wearing a mask would create a risk to workplace health, safety, or job duty as determined by the relevant workplace safety guidelines or federal regulations. • To facilitate learning and social and emotional development, consider having staff who are not fully vaccinated wear a clear or cloth mask with a clear panel when interacting with young children, children learning to read, or when interacting with people who rely on reading lips. • When masks are worn by child care providers and staff in the workplace, the masks should meet one of the following criteria: • CDC mask recommendations • ASTM International Standard Specification for Barrier Face Coverings • NIOSH Workplace Performance and Workplace Performance Plus masks

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• Resources on masks • How masks control the spread of SARS-CoV-2 • How to select, wear, and clean your mask • Post signs on how to stop the spread of COVID-19, properly wash hands, promote everyday protective measures, and properly wear a face covering. • Find freely available CDC print and digital resources on CDC’s communication resources main page. CDC also has videos including one with American Sign Language related to COVID-19 and other communication tools. • CDC has also created several resources and infographics for child care providers available at CDC’s toolkit for child care programs.

Physical Distancing

What are Delaware’s required practices? All Delaware programs must follow the current DELACARE Regulations.

For the health and safety of staff and children in your care, the following practices are strongly recommended but are no longer required: • Social distancing between adults and children is recommended when possible but not required.

What are additional recommended practices? From Centers for Disease Control and Prevention • ECE programs where not everyone is fully vaccinated should implement physical distancing to the extent possible indoors. Because of the essential service that ECE programs provide, ECE programs should not exclude children from in-person care to keep a minimum distance requirement. • Maintaining physical distance is often not feasible in an ECE setting, especially during certain activities (e.g., diapering, feeding, holding/comforting, etc.) and among younger children in general. When it is not possible to maintain physical distance in ECE settings, it is especially important to layer multiple prevention strategies, such as cohorting, masking indoors, improved ventilation, handwashing, covering coughs and sneezes, and regular cleaning to help reduce transmission risk. Mask use by people who are not fully vaccinated is particularly important when physical distance cannot be maintained. A distance of at least 6 feet is recommended between adults who are not fully vaccinated. Place children and child care providers into distinct groups that stay together throughout an entire day. • People who are fully vaccinated do not need to physically distance except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance. Although challenging and at times not possible in an ECE setting, people who are not fully vaccinated should physically distance from others who are not fully vaccinated as much as possible and wear a mask. • If transport vehicles (for example, buses or vans) are used by your program, drivers should practice all safety actions and protocols as indicated for other staff (for example, hand hygiene, masks). To clean and disinfect buses or other transport vehicles, see guidance for bus transit operators. Create distance

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between children on transport buses (for example, seat children one child per row, skip rows) when possible. However, children from the same home can be seated together.

Outside Play & Physically Active Play

What are Delaware’s required practices? All Delaware programs must follow the current DELACARE Regulations.

What are additional recommended practices? From Centers for Disease Control and Prevention • In general, children and adults do not need to wear masks when outdoors (e.g., participating in outdoor play, recess, and physical education activities). However, in areas of substantial to high transmission levels, people who are not fully vaccinated are encouraged to wear a mask in crowded outdoor settings or during activities that involve sustained close contact with other people who are not fully vaccinated. When physically active play, physical education activities, and recess are held indoors, people who are not fully vaccinated should wear masks and maximize distance when possible. • Physical activities provide children with enrichment opportunities that supports physical development and can help them learn and achieve, and support their social, emotional, and mental health. Due to increased exhalation, some physical activities can put people who are not fully vaccinated at increased risk for getting and spreading COVID-19. Similar risks might exist for other indoor activities, such as singing, chanting, and yelling. • Preventing COVID-19 for those who are not fully vaccinated in these activities remains important. Children who participate in indoor physical activity and other higher-risk activities should continue to wear masks and keep physical distance and remain in their cohort as much as possible. • ECE providers who are planning structured physically active play should also consider risks for people who are not fully vaccinated: • Setting of the event or activity. In general, the risk of COVID-19 transmission is lower when playing outdoors than in indoor settings. Consider the ability to keep physical distancing in various settings at the event. • Physical closeness. Spread of COVID-19 is more likely to occur in physical activity and sports that require sustained close contact. • Number of people. Risk of spread of COVID-19 increases with increasing numbers of participants. • Level of intensity of activity. The risk of COVID-19 spread increases with the intensity of the physical activity. • Duration of time. The risk of COVID-19 spread increases the more time participants spend in close proximity or in indoor group settings. • Presence of people more likely to develop severe illness. People at increased risk of severe illness might need to take extra precautions.

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Meals & Snacks

During meals and snack times, germs and pathogens are easily passed from person to person when proper food safety precautions are not taken.

What are Delaware’s required practices? All Delaware programs must follow the current DELACARE Regulations.

What are additional recommended practices? The Child and Adult Care Food Program (CACFP) offers free resources, including video snippets on food safety procedures such as handwashing. These videos and more can be found on the CACFP website.

From Centers for Disease Control and Prevention • Maximize physical distance as much as possible between people who are not fully vaccinated while eating (especially indoors). When possible, consider using additional spaces for mealtime seating, including eating meals and snacks outdoors or in well-ventilated spaces whenever possible. • Given very low risk of transmission from food, food packaging, surfaces and shared objects, there is no need to limit food service operations to single use items and packaged meals. • People should wash hands with soap and water before and after family style meals. • Clean frequently touched surfaces. Surfaces that come in contact with food should be washed and sanitized before and after meals. • Promote hand washing before, during, and after shifts, before and after eating, after using the toilet, and after handling garbage, dirty dishes, or removing gloves. • Improve ventilation in food preparation, service, and eating areas. • U.S. Department of Agriculture has issued several Child Nutrition COVID-19 Waivers. Learn more here. • It is important that you comfort crying, sad, or anxious infants and toddlers and they often need to be held. To the extent possible when holding, washing, or feeding young children, protect yourself by:

o Washing your hands frequently. o Wash your hands, neck, and anywhere you have been touched by a child’s body fluids. o Avoid touching your eyes while holding, washing, or feeding a child. o If body fluids get on the child’s clothes, change them right away, whenever possible, and then your hands should be rewashed. o Wash your hands before and after handling infant bottles prepared at home or in the facility.

Activities What are Delaware’s required practices? All Delaware programs must follow the current DELACARE Regulations.

This includes, screen time activities require written parent/guardian permission and are limited to one hour or less per day, unless a special event occurs. Children younger than two years are prohibited from participating in screen time activities. Assistive technology is not included in screen time restrictions.

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WHAT SHOULD I DO IF SOMEONE IN MY PROGRAM GETS SICK?

What are Delaware’s required practices? • Reporting of positive COVID-19 cases (staff or children) to DPH is required. It is covered under the category of Severe Acute Respiratory Syndrome (SARS) – as SARS CoV-2 is the virus that causes COVID-19. A full list of notifiable diseases is listed here. After reporting a positive case of COVID-19 to DPH, reporting this information to your licensing specialist is also required. This report must be made within 24 hours of learning of the positive case of COVID-19 in your child care home or center. • To report new positive COVID-19 cases to DPH, use the revised, fillable data collection form 3.5 and submit it through DPH's NEW online system, available now: https://redcap.dhss.delaware.gov/surveys/?s=9HK8A4J4AX. Through this form, you can report a case, request a clearance letter, and request a call back from an epidemiologist. o Alternatively, continue to submit the data collection form via Fax (302-223-1540) or Email ([email protected]) and indicate if you need a call back. o If you have a COVID-19 related question, please email [email protected]. • Please do not report close contacts to DPH who were not in the early childhood education setting (for example, a child who is being quarantined because a parent tested positive if that parent had not been in the early childhood education setting). Please ask that the positive case (i.e. parent or staff) share that they are connected to an early childhood education setting when they speak with contact tracers. If families or staff do not hear from a contact tracer, please advise them to call 844-611-3231. • Additional information and advice from the Delaware Department of Public Health (DPH) can be found in the FAQs for Responding to COVID in Licensed Child Care Facilities. Steps for child care programs to respond to positive or possible COVID-19 cases are outlined in the Navigating COVID-19 graphic. • Facilities with positive cases should contact DPH at [email protected] or 2-1-1 for cleaning guidance specific to their facility. • Providers must notify OCCL within one business day in the event that they decide to close the facility.

From Centers for Disease Control and Prevention Close Contacts of Persons with COVID-19 • Whether and for how long to stay home for people who have been exposed to a person with COVID-19 depends on vaccination status. o Children and unvaccinated staff who had close contact with someone who has (suspected or confirmed) COVID-19 should stay home (quarantine) for 14 days after their last exposure to that person. Close contact is defined as within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period. Some localities might choose to use testing to shorten quarantine. o People who are fully vaccinated and do not have COVID-19 symptoms do not need to quarantine or get tested after an exposure to someone with COVID-19. o ECE programs should educate staff and families about when they and their children should stay home and when they can return to ECE programs.

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Preparing for When Someone is Sick Your ECE program should implement multiple COVID-19 prevention actions to prepare for when someone is sick with COVID-19. • Your children or staff might begin to have COVID-19 symptoms while at your facility. You should take action to isolate people who begin to have these symptoms from other children and staff. Plan to have an isolation room or an area, preferably with access to a separate restroom, you can use to isolate a sick child or staff member. Ensure that isolated children are still under adult supervision. Arrange safe transportation home or to a healthcare facility (if severe symptoms) for the child or staff if showing symptoms of COVID-19. • Close off areas used by a sick person and do not use these areas until after cleaning and disinfecting them; this includes surfaces or shared objects in the area, if applicable. • Wait at least 24 hours before cleaning and disinfecting. If 24 hours is not feasible, wait as long as possible and increase ventilation in the area. You should ensure safe and proper use of cleaning and disinfection products, including storing products securely away from children. • See CDC’s Toolkit for Child Care Programs for more resources on what to do if a child becomes sick while at the child care program.

Contact Tracing in Combination with Isolation and Quarantine • ECE programs should continue to collaborate with state and local health departments, to the extent allowable by privacy laws and other applicable laws, to confidentially provide information about

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people diagnosed with or exposed to COVID-19. This allows identifying which children and staff with positive COVID-19 test results should isolate, and which close contacts should quarantine. • ECE programs should report, to the extent allowable by applicable privacy laws, positive cases to their state or local health department as soon as they are informed. ECE administrators should notify, to the extent allowable by applicable privacy laws, staff and families of children who were close contacts as soon as possible (within the same day if possible) after they are notified that someone in the program has tested positive. Fully vaccinated people who were in close contact with someone who has COVID- 19 but do not have COVID-19 symptoms do not need to quarantine or be tested. • Resources on isolation, quarantine, and testing • Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination • When to quarantine and COVID-19 testing • COVID-19 information for Workplaces and Businesses

• Visit the CDC site for additional information on recommended procedures. • The CDC offers the following resources: o What to Do if a Child Becomes Sick or Receives a New COVID-19 Diagnosis in your Child Care Center Flowchart o What to Do if a Child Becomes Sick or Receives a New COVID-19 Diagnosis in your Family Child Care Home Flowchart o A Child is Showing Signs of COVID-19 in my Child Care Program: What Should I Do? Quick Guide for Providers

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APPENDIX: WHAT SHOULD I KNOW ABOUT COVID-19 VACCINATIONS?

Where can I find information about vaccines? Vaccination is currently the leading public health prevention strategy to end the COVID-19 pandemic. Promoting vaccination among eligible individuals can help Early Care and Education (ECE) programs protect staff and children in their care, as well as their families.

People who are fully vaccinated against COVID-19 are at low risk of symptomatic or severe infection. A growing body of evidence suggests that people who are fully vaccinated against COVID-19 are less likely to have an asymptomatic infection or transmit COVID-19 to others than people who are not fully vaccinated. In most settings, people who are fully vaccinated and do not have compromised immune systems can safely resume activities they did before the pandemic, except where prevention measures are required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.

Vaccines are an important tool to help stop the COVID-19 pandemic. Early care and education providers hold jobs critical to the continued functioning of society and are at potential occupational risk of exposure to SARS- CoV-2. As frontline essential workers, child care providers have been prioritized nationally to receive vaccination. More information can be found here.

New variants of the virus that causes COVID-19 are spreading in the United States. Current data suggest that COVID-19 vaccines authorized for use in the United States offer protection against the circulating variants. CDC will continue to monitor variants to see if they have any impact on prevention strategies and how COVID- 19 vaccines work in real-world conditions and will update guidance accordingly. For more information see: COVID-19 Vaccines.

Should I get vaccinated? Getting vaccinated as soon as the opportunity is available is an important way for you and your staff to stay safe and reduce the risk of getting seriously ill from COVID-19. Review CDC’s COVID-19 Vaccination Information or talk to your healthcare provider for more information.

Where can I get vaccinated? https://coronavirus.delaware.gov/vaccine/ https://coronavirus.delaware.gov/vaccine/vaccine-planning-for-agencies-organizations-businesses/ https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html

What can I share with staff and families about the vaccine? People 12 years and older are now eligible for COVID-19 vaccination, but most ECE programs serve children under 12 years old. ECE programs can promote vaccinations among staff and families, including pregnant women, by providing information about COVID-19 vaccination, encouraging vaccine trust and confidence, and establishing supportive policies and practices that make getting vaccinated as easy and convenient as possible.

Existing laws and regulations require certain vaccinations for children attending ECE programs. ECE administrators regularly maintain documentation of children’s immunization records. Since recommended prevention strategies vary by COVID-19 vaccination status, ECE administrators who maintain documentation of children’s and workers’ COVID-19 vaccination status can use this information (consistent with applicable

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laws and regulations, including those related to privacy), to inform masking and physical distancing practices, testing, contact tracing efforts, and quarantine and isolation practices. Additional information is located here.

The COVID-19 Vaccines for Teachers, School Staff, and Childcare Workers webpage provides school and childcare staff with the latest information about where and how to book an appointment.

The COVID-19 Vaccine Toolkit for School Settings and Childcare Programs provides schools and childcare programs with ready-made materials they can use to communicate with staff about COVID-19 vaccination. CDC will continue to add more materials to this toolkit. Please check back frequently for updates.

Will booster vaccines be necessary? HHS announced a plan to begin offering COVID-19 vaccine booster shots this fall. CDC’s independent advisory committee, the Advisory Committee on Immunization Practices, will continue to meet and discuss data on the evolution of the pandemic and the use of COVID-19 vaccines. ACIP will make further recommendations on the use of boosters for the public after a thorough review of the evidence.

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APPENDIX: HOW CAN I SUPPORT THE SOCIAL AND EMOTIONAL NEEDS OF EVERYONE IN MY PROGRAM?

This is a stressful time, and it is important to support the mental well-being of everyone in your program, including children, families, staff, and yourself, as programs close, transition, and reopen. Below are resources that may be helpful to you in meeting the ongoing social-emotional needs of those in your program:

Supporting Early Childhood Professionals

There are many resources for self-care for early childhood professionals while their programs are closed as well as when the programs are open and are serving families. Strategies can include:

• Virtual trainings and webinars (recorded or live)

Existing Delaware trainings and supports related to well-being and self-care o DIEEC-PD https://dieecpd.org/ . Virtual training with Community of Practice - Stress and Resilience: Building Core Capabilities . Virtual, live training - Mindfulness: A Resilience Practice o Early Childhood Mental Health Consultation [email protected] 302-256-9308 . Consultants can facilitate self-care and mindfulness training, help programs reduce teacher and caregiver stress, and support social and emotional wellbeing o Mental Health DE https://mentalhealthde.com/mental-wellness/

Established professional organizations offering wellness/self-care webinars and resources o Administration for Children & Families, Early Childhood Training & Technical Assistance System . Practicing Self-Care and Professionalism: https://childcareta.acf.hhs.gov/sites/default/files/public/itrg/article_self- care_for_teachers.pdf o Centers for Disease Control & Prevention (CDC) . Managing Stress and Anxiety: https://www.cdc.gov/coronavirus/2019-ncov/daily-life- coping/managing-stress-anxiety.html o Collaborative for Academic, Social, and Emotional Learning (CASEL) • General social and emotional learning resources: https://casel.org/ . Weekly Webinars: https://casel.org/weekly-webinars/ o Mental Health America . Webinar: Wellness Routines for Uncertain Times: https://www.mhanational.org/events/wellness-routines-uncertain-times o National Association for the Education of Young Children (NAEYC) . Talking to and Supporting Children and Ourselves During the Pandemic: https://register.gotowebinar.com/register/4843463476337444880 . Remember to Take Care of Yourself: Six Ideas for Family Child Care Providers: https://www.naeyc.org/resources/blog/six-ideas-family-child-care-providers Page | 30

o Office of Head Start . COVID-19 Check-In: https://eclkc.ohs.acf.hhs.gov/blog/covid-19-check o ZERO TO THREE . Mindfulness Breaks: A Weekly Series for Self-Care: https://www.zerotothree.org/resources/3351-mindfulness-breaks-a-weekly-series-for-self- care . Mindfulness Toolkit: https://www.zerotothree.org/resources/2896-getting-started-with- mindfulness-a-toolkit-for-early-childhood-organizations

• Virtual staff meetings held prior to reopening. This time can be spent explaining changes in program operations and environments that have been put in place to help ensure the safety and health of staff, children, and families. Allowing time for and responding to questions can help minimize staff stress.

• Virtual communities of practice and/or a buddy system to provide opportunities to talk about their experiences. Sharing personal observations can facilitate a sense of community support.

• Monitoring staff well-being, either formally or informally. There are several methods that center administrators and family child care networks can use to gather information about the overall well-being of educators who provide direct service to children and families. Incorporate brief check-ins into daily routines for regular and quick touchpoints. This information can guide you in choosing resources for your colleagues. Some possibilities include: o A digital poll (e.g., Google poll) that allows educators to register their mental or emotional state. A sample prompt might include, “How are you feeling today?” with response options of “Great,” “Okay,” and “I’m struggling.” If wanted, responses can be anonymous. o A physical poll that allows staff the same options. There are many possibilities that could also allow for privacy, including color-coded response systems. (e.g., stickers, Post-It Notes).

Talking with Children about COVID-19

Early childhood professionals are well-versed in developmentally appropriate ways to talk with children about difficult subjects, as well as appropriate communications with families. Discussions regarding the COVID-19 pandemic, its implications for young children and their families, and changes in children’s environments and routines should follow the same guidelines early childhood professionals use for talking about other difficult topics.

Prior to Reopening Centers and Homes The transition back to child care can be stressful for children and their families. We all need to be tuned in to children’s and family members’ emotional needs. Part of the back-to-child-care transition strategies could be a video introduction to the classroom or family child care home. Offer a chance to see the educator without a cloth face covering and with the cloth face covering on—showing that this is the same person. If possible, online chats one-to-one with the child’s educators prior to reopening can also ease the transition for returning children and help to begin building relationships with new enrollees and their families. And, as programs prepare to reopen, it would be helpful for the early childhood professionals to prepare large pictures of their faces to pin onto their shirts so that children can see who the person is behind the cloth face covering.

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Strategies for Talking with Children

● First, it’s important to deal with your own anxiety and fears about COVID-19. When you’re feeling anxious about the virus or about the pandemic—that’s not a good time to talk with young children, who will certainly pick up on your anxiety and concern. Use whatever methods that you typically use to be calm in troublesome situations—be that meditation, exercise, yoga, talking with colleagues, etc. See the strategies noted in the previous section, Supporting Early Childhood Professionals.

● Remain calm and reassuring as you talk with children. Reassure children that when we follow the guidelines for what we’re supposed to be doing to stay safe and healthy, there is a small chance that they will become infected and get sick. o A note of caution from the Federal Substance Abuse and Mental Health Services Administration (SAMHSA): Be careful not to pressure children to talk about the outbreak or join in expressive activities. While most children will easily talk about the outbreak, some may feel frightened. Some may even feel more anxiety and stress if they talk about it, listen to others talk about it, or look at artwork related to the outbreak. Allow children to remove themselves from these activities and monitor them for signs of distress.

● Share with children what you are doing to stay safe—and what they will be doing, as well. “Our strategies include washing hands thoroughly—for example, singing Happy Birthday twice while lathering up and washing—when we come in from the outside; before we eat; after blowing our noses, coughing, sneezing, or using the bathroom. We also practice physical distancing—staying 6 feet away from others.” You can use a variety of methods with primarily nonstandard measures to help young children be aware of the 6- foot distance, such as using a 6-foot string to help children see what 6 feet looks like, the distance from the table toys bookcase to the music area (or other areas that are 6 feet apart).

● Do not use or reinforce language that might blame others and lead to stigma. Children might have heard adults stating misinformation or biased opinions, calling COVID-19 the Chinese virus, or that Blacks and Hispanics are more at risk than other groups, etc. Use correct terminology (COVID-19) and, when necessary, remind children that viruses can make anyone sick, regardless of a person’s race or ethnicity.

● Discuss COVID-19 in a developmentally appropriate way. Children are most likely hearing about COVID-19 from the TV, online programs, parents’ discussions, etc. Help children feel informed and reassured. “COVID-19 can look different in different people. For many people, being sick with COVID-19 would be a little bit like having the flu. People can get a fever, cough, or have a hard time taking deep breaths. Most people who have gotten COVID-19 have not gotten very sick. These people stay home, rest, and try to stay away from others. Some people with COVID-19 have to go to the hospital for care by doctors and nurses.” o The National Association for the Education of Young Children (NAEYC) offers this additional resource: Talking to and Supporting Children and Ourselves During the Pandemic https://register.gotowebinar.com/register/4843463476337444880

● Encourage children to ask questions and talk about what they know about COVID-19 and what they may fear. Respond in ways that are factual and reassuring. If you are unsure of the facts, the sites referenced throughout are good sources for current information.

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● Stick to previously established routines and, as necessary, create new or modified routines and stick to these. Explain to children what the new routine is and why we’re using it, such as: o “We don’t do circle time with the whole group now because it’s difficult for all of us to be 6 feet apart in our classroom or FCC home.” o “We won’t be eating family style, but the teachers will give each child a plate of food at snack and mealtime(s) so that we’re not all touching the serving utensils.”

Changes in the Environment and Routines to be Discussed with Children

The guidance from the Centers for Disease Control, the Office of the Governor, and other sources will involve changes to the environment and routines. Children will notice! It’s important to address these changes up front with children and family members to minimize their anxiety.

These changes could include: ● Caregivers who typically bring their child into the program, will now leave their child at the entry of the program, and an early childhood professional will escort the child to his or her classroom, or the family child care home area where children play. ● All the adults are wearing cloth face coverings so that they don’t spread any germs. ● An early childhood professional is taking the temperature of everyone who comes into the center or home. ● All the plush and soft toys have been removed because these are not easily cleaned, sanitized, or disinfected. ● Snacks and meals are plated, not served family style. ● The cots are farther apart at naptime. ● Children remain in their classroom for the whole day—groups are not combined in the beginning or toward the end of the day when the number of children in the center is lower. ● Not all areas are open, such as sensory or sand play, modeling with play-dough and clay. Some areas are doubled to ensure smaller groups of children at play, such as having two block areas and/or two dramatic play areas (if space allows, of course). ● Toys, tables, bookcases, and other surfaces are cleaned more often than pre-COVID-19. ● No large-group time in programs—perhaps replaced by several small-group activities. ● Only one group at a time will use the outdoor area (if your program typically allows multiple classrooms to use the outdoor area simultaneously). Additional Resources for Talking with Children about COVID-19: ● Centers for Disease Control (CDC). Talking with Children about Coronavirus Disease 2019 ● Child Mind Institute. Talking to Kids about the Coronavirus Crisis ● Substance Abuse and Mental Health Services Administration (SAMHSA). Talking with Children: Tips for Caregiver, Parents, and Teachers during Infectious Disease Outbreaks ● National Association for the Education of Young Children (NAEYC). The Power of Storytelling in Early Childhood: Helping Children Process the Coronavirus Crisis ● National Association of School Psychologists (NASP): Talking to Children about COVID-19, available in English and Spanish ● Public Broadcasting Service (PBS): 10 Tips for Talking About COVID-19 with your Kids ● Public Broadcasting Service (PBS): (Video) WATCH: 5 tips for talking to children about COVID-19 ● Help Guide: Helping Children Cope with Traumatic Events

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APPENDIX: HOW CAN I MAKE SURE MY PROGRAM IS READY?

Whether you are currently open or are planning for when you are opening again, it is important to engage in regular risk management assessments of your program. A risk management assessment is a simple tool to ensure that you are planning for all situations that may occur. The guidance below is designed to support programs in developing their written plan for COVID-19. See CDC’s feature on helping young children and parents transition back to school.

Preparedness and Planning

Mandated Requirements Considerations

• How will I provide cloth face coverings for staff? • How will I communicate the program’s cloth face covering policy to staff and families? • How will I educate my families and staff on why face coverings are necessary, how to wear them, and how to remove them? • How can I support families to help their children be more comfortable with Follow the current requirements for cloth face wearing face coverings? coverings • What will I do if a staff member refuses to wear a cloth face covering? • What will I do if a parent/guardian refuses to follow the program’s cloth face covering policy? • How will children’s face coverings be stored during times when they cannot be worn? • Do I have a need for any health care grade masks? • How will I train my staff on proper face covering procedures?

Recommendations Considerations

• How can I educate myself on the preventative measures that can be taken to prevent the spread? • How will I educate staff and families about the preventative measures they should take and why these measures are important? Practice every day preventative measures • What will I do to ensure staff/children/families are practicing preventative measures? • What procedures will we follow? • How will I train my staff on these new procedures?

• Post DPH signage How will I access printed copies of signage? • Where will I post signage, so it is visible to staff and families?

• How many staff do I need to cover each classroom, as well as the additional responsibilities (cleaning, mealtime, etc.)? • Plan for staff absences How will staff notify me if they are sick? What information will I want to know? • How will I monitor absenteeism to identify trends in illness? • How will I ensure that I have enough staff in the event someone calls out? • What information should I share with staff if they are ill?

Plan for if/when a child/staff member becomes • Where will a child be cared for if they become sick? • Who will care for them? Will this person wear different PPE while caring for the ill while at child care ill child?

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• How will I ensure that I have an immediate substitute if a staff member falls ill during work?

Encourage high-risk staff to contact their • Which of my staff are considered high-risk? • What can I do to ensure that they stay safe while at work? health care provider • What will high-risk staff do if there is a suspected case in the facility?

• Who will I contact if there is a positive case of COVID-19 in my facility? Plan for a positive case of COVID-19 • What cleaning procedures will I take? • What cleaning supplies will I need?

Preparedness and Planning Resources

Preventative Measures Handwashing CDC Guidance-Prevention Caring for Our Children-Handwashing Procedure CDC Guidance-People at Higher Risk Caring for Our Children-Handwashing Schedules CDC Guidance-General Preparedness and Planning CDC Handwashing Information CDC What You Need to Know About Handwashing Video Face Coverings CDC When and How to Wash Your Hands DPH COVID-19 Guidance Face Coverings for Children Signage CDC Information about Cloth Face Coverings CDC How to Stop the Spread CDC Use of Cloth Face Coverings to Help Slow the DPH Signage Spread CDC Handwashing Posters Sequence for putting on/removing masks Cloth Face Coverings for Children Caring for Ill Children/Staff CDC Guidance-Caring for Someone CDC Guidance-Steps When Sick

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Arrival/Drop-off and Screening Procedures

Recommendations Considerations

• How will staff be screened? • What will the process be for screening children? • What supplies do I need to complete the screening process? • How many of each item will I need to ensure all screeners have the appropriate Adhere to screening practices for adults and materials? • How will I track that children/staff have been screened each day? children entering the facility • Who will bring the children to their classroom? • Who will be responsible for screening children? • How will I train those who are responsible for screening? • How will I protect the health of those staff members who will be completing child health screenings each day?

• Under what circumstances should staff stay home? Remind staff to stay at home if they are sick • How should staff communicate their symptoms to the facility? • When are staff permitted to return to work?

• Under what circumstances should children stay home? Remind parents to monitor children for signs of • How should parents/guardians communicate their child’s symptoms to the illness and keep them home if they are sick facility? • When are children permitted to return to the program?

• How will I determine when each family will drop off and pick up? Stagger arrival/drop-off times and pick up • How will I communicate this information to each family? • What do parents need to do if they need to drop off or pick up outside of their times assigned time? • How can I encourage the same person to drop off/pick up each day?

Arrival/Drop-off and Screening Procedures Resources

Sequence for putting on/removing PPE CDC Guidance-Parent Drop-off and Pick-up

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Stable Groups and Social Distancing

Recommendations Considerations

• How can I schedule staff to minimize the number of individuals in the classroom? • Can I adjust schedules to allow more children to enroll while keeping to the required group size? Follow DELACARE Regulations regarding • How will I handle times of the day with lower enrollment to prevent mixing of ratios and group size, while practicing social groups? distancing to the extent practical given the o If groups need to be combined in morning/afternoon, where is the best age, ability, and social and emotional needs location that can ensure social distancing and easy sanitation? of the children in care. • How will I handle staff call outs to prevent shifting children into other classrooms? • How can I use the physical space in the room to encourage social distancing? • How can I manage child play within centers to encourage social distancing?

• How can I schedule the playground for one group at a time? Stagger the use of shared spaces • Does this schedule allow enough time for children to transition to and from the space to ensure groups do not mix or pass each other? (playgrounds, cafeterias, etc.) • Do these times allow for cleaning between the classes? • Who is responsible for the cleaning between classes?

Cancel large group activities where children • Is there another way to complete these activities in smaller groups where the children can be six feet apart? cannot be at least 6 feet apart • How will I help the children understand the new procedures?

Ensure that children’s naptime mats or cribs • How can I use the floor space to spread children’s cots throughout the room? are spaced out as much as possible and/or o Can large furnishings, such as shelves, be moved to accommodate placed head-to-toe and follow DELACARE additional spacing at naptime? Regulations for spacing • Are there areas you typically do not use or use less frequently?

Stable Groups and Social Distancing Resources

CDC Guidance: Social Distancing Strategies Strategies for Talking with Children on page 37 of Re-Opening Delaware Early Care and Education Safely

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Sanitation and Cleaning Practices

Recommendations Considerations

• What materials do I need to remove from my child care space? • What cleaning supplies will I need? • How can additional cleaning be done in a manner that does not interfere with engaging with the children? • How can my teachers educate the children in these expectations? • Are there staff who can be designated for cleaning areas of the building Adhere to the recommended cleaning, throughout the day? • sanitizing, and disinfecting practices How will my teachers receive training in these practices to ensure that they are able to follow through on expectations? o Who is responsible for the additional cleaning throughout the day? o When will daily cleaning take place? • How will I support and track that the additional cleaning is being completed? • Who is responsible for cleaning the common areas?

• What cleaning supplies will I need? • Can the toys in the classroom be cleaned? If not, is there an alternate Clean all toys at the end of each day following material that could be used to meet the same goal? CDC recommendations • Who will clean toys each day? • When will daily cleaning take place? • Is this part of the daily cleaning schedule?

• How is this different from our normal mealtime? Ensure that meals, if served, are individually • Who will be responsible? plated • Are there other alternatives? (Children bring their own food from home?)

• What materials cannot be easily cleaned or laundered? • Minimize the use of soft toys or other toys that What are other materials that could replace those not easily laundered to meet the same goal? cannot be easily cleaned or laundered • Are there other ways to give children access to softness in the classroom?

Sanitation and Cleaning Practices Resources

CDC Guidance-Cleaning and Disinfecting Caring for Our Children-Routine Schedule for Cleaning, Sanitizing, and Disinfecting A Flash of Food Safety Videos

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